Brazil, Once a Leader, Struggles to Contain Virus Amid Political Turmoil

Thronged banks. Packed subway cars. Buses full of President Jair Bolsonaro’s fervent supporters, heading to rallies that call on Brazilians to brush aside stay-at-home orders from mayors and governors and instead follow the president’s directive to get back to work.

Scenes like these are a reflection of Brazil’s contradictory and chaotic response to the coronavirus pandemic, which was on glaring display on Friday when the health minister resigned — just weeks after his predecessor was abruptly fired following clashes with Mr. Bolsonaro.

The national confusion has helped fuel the spread of the disease and contributed to making Brazil an emerging center of the pandemic, with a daily death rate second only to that of the United States.

Public health experts say the disorderly approach has further saturated intensive care units and morgues and contributed to the deaths of scores of medical professionals as Latin America’s largest economy plunges into what may be its steepest recession in history.

The crisis facing the country stands in stark contrast to Brazil’s track record for innovative and nimble responses to health care challenges that made it a model in the developing world in decades past.

“Brazil’s could have been one of the best responses to this pandemic,” said Marcia Castro, a professor at Harvard University who is from Brazil and specializes in global health. “But right now everything is completely disorganized and no one is working toward joint solutions. This has a cost, and the cost is human lives.”

Brazil had months to study the errors and successes of the first countries struck by the virus. Its robust public health care system could have been deployed to conduct mass testing and trace the movements of newly infected patients.

Its failure to act early and aggressively is at odds with the country’s ingenious approaches to past medical crises, health experts said.

After a surge in H.I.V. infections in the 1990s, Brazil offered free and universal treatment and pushed the pharmaceutical industry to lower costs. It threatened to disregard a Swiss drugmaker’s patent for an H.I.V. drug in 2001, and did so in 2007, manufacturing its own generic version and greatly reducing the prevalence of H.I.V.

In 2013, Brazil vastly expanded access to preventive health care in poor areas by hiring thousands of foreign doctors, most of them Cuban. And to combat the Zika outbreak in 2014, Brazil created genetically modified mosquitoes that helped decrease the insect’s population, a tactic that will soon be deployed in Florida and Texas.

Brazil’s prior success resulted from investment in science and empowerment of scientists, said Tania Lago, a professor of medicine at Santa Casa University in São Paulo, who worked in the ministry of health in the 1990s.

“Now there’s been a rupture in the nation with its scientific community,” she said. “What saddens me is that we are and will continue to lose lives that could be saved.”

As countries started taking drastic measures to curb the spread of the virus in February and March, Mr. Bolsonaro played down the risks and encouraged public gatherings. Now, he is urging Brazilians to return to work even as the number of new cases and deaths are spiking.

This past week, the president issued an executive order classifying gyms and beauty salons as essential businesses that should reopen.

As of Friday, Brazil had 218,223 diagnosed cases of coronavirus and 14,817 deaths. But the actual death toll is likely to be much higher, according to death records compiled by Fiocruz, a government institute that studies health care trends.

Between Jan. 1 and May 9, official government figures say 10,627 people died in Brazil of Covid-19, the disease caused by the coronavirus.

During that period, an additional 11,026 people who were not diagnosed with the coronavirus died from acute respiratory infections.

That number is several thousands more than the average number of deaths from respiratory ailments in recent years, said Marcelo Gomes, a researcher at Fiocruz. He said he suspected a significant percentage of those patients died from undiagnosed coronavirus infections.

According to the Institute for Health Metrics and Evaluation at the University of Washington, the virus is on track to kill more than 88,000 people in Brazil by early August.

Brazil’s Federal Council of Nursing said insufficient protective equipment and punishing workloads have exposed thousands of medical professionals to the virus, leaving hospitals understaffed.

“Because salaries are low, most work in two places, some three,” said Manoel Neri, the president of the council. “This is a longstanding problem in Brazil.”

The council said at least 108 nurses and medical technicians have died from confirmed or suspected coronavirus cases in recent weeks. More than 13,500 have developed symptoms, but many have been unable to get tested.

Jacqueline, a 37-year-old nurse in Rio de Janeiro who contracted the virus along with her husband, also a nurse, said fear is pervasive among her colleagues.

“We feel exposed,” said Jacqueline, who asked to be identified by first name only because she fears reprisals from her employer. “You look around and people are crying because they’re fearful of taking the virus to our families.”

The political turmoil that has whiplashed the health ministry over the past few weeks has further hurt the country’s ability to prepare for the pandemic.

The health minister, Nelson Teich, resigned on Friday, just days shy of completing a month on the job.

Mr. Bolsonaro fired his predecessor, Luiz Henrique Mandetta, after the two clashed over the president’s disdain for quarantine measures.

In an interview, Mr. Mandetta said Brazil’s “erratic” response to the pandemic left it ill-equipped to compete in a global scramble for ventilators, tests and protective equipment for medical personnel.

“Our challenge is to expand health coverage while competing with the absurd spending power of the United States and Europe,” he said.

Flávio Dino, the governor of Maranhão State, said the federal government has been an obstacle as state officials have shopped for ventilators and put up field hospitals. The state capital, São Luís, was the first in the country to impose a strict lockdown this month, requiring everyone other than essential workers to stay home.

“At the national level, there wasn’t a plan to prepare for this trying month of May,” he said. He called the firing of Mr. Mandetta a setback. “You don’t change the crew of an airplane mid-flight.”

The impoverished State of Amazonas, in the north, has seen its hospitals overloaded and its cemeteries resorting to mass graves in order to cope with the deluge of bodies.

Arthur Virgílio Neto, the mayor of Manaus, the state capital, has cried during televised interviews as he pleaded for federal assistance. Mr. Bolsonaro, with his disregard for social distancing and other preventive measures, has been part of the problem, Mr. Virgílio said.

“People never stopped roaming the streets; there has been flagrant disregard for our decrees,” he said, blaming Mr. Bolsonaro. “He is against social distancing, and that explains part of the disobedience.”

Facing mounting criticism, the Bolsonaro administration, which declined to comment, launched a campaign this past week that highlighted the president’s concern over the economy, which is projected to contract by at least 5 percent this year.

“Those lockdowns, they’re not the path — they’re the path to failure,” Mr. Bolsonaro said on Thursday, addressing supporters outside the presidential palace. He added, disparagingly, “It will turn into a country of misery, like a country in sub-Saharan Africa.”

Ms. Castro, the Harvard professor, said the government’s failure to mount an effective response is likely to lead to a series of outbreaks that will do more damage to the economy in the long run.

“How can you promote economic growth if your population is sick?” she said. “A sick work force can’t work.”